Obviously, folks who work in healthcare should strongly consider getting vaccinated as long as they don’t have a health condition that could be compromised by the vaccine or object to it on religious grounds. Not only are caregivers likely to come into contact with infected citizens, they can also spread it to others even if they don’t feel sick.

Both CDC’s Advisory Committee on Immunization Practices and its Healthcare Infection Control Practices Advisory Committee recommend that all U.S. healthcare workers get vaccinated annually. But in many states, they are not required by law to do so.

The Department of Health and Human Services (HHS) has a new head honcho.

By a 55-43 vote, the Senate on Wednesday afternoon confirmed Alex Azar, President Donald Trump’s pick to replace Tom Price as HHS secretary. Price, of course, resigned last September amid scrutiny over his use of taxpayer-paid private planes.

He will be tasked with guiding the future of the Affordable Care Act and reining in prices charged by drug companies. The latter was a point of contention for the many Democrats who opposed the appointment because while Azar was president of Eli Lilly, that drug manufacturer spiked the price of some prescription drugs.

“He failed to persuade me that he can effectively lead any effort to lower drug prices given his tenure at Eli Lilly, where he worked to raise drug prices on patients,” Sen. Patty Murray of Washington, the top Democrat on the health committee, said when announcing her opposition to his nomination. “He indicated in our discussions that he would continue the Administration’s harmful plan to create Trumpcare by sabotage.”

Senator Orrin G. Hatch (R-Utah), the chairman of the Finance Committee, believes Azar’s background as a drug company executive is an asset and told him, “You’re one of the best public servants that I’ve seen in the whole time I’ve been here.”

If you have yet to get your flu shot, it’s not too late, says CDC, which is urging citizens “to take every advantage that you can to protect yourself” from what officials are calling one of the most severe flu seasons in years.

The dominant strain this flu season, influenza A (H3N2), is present in every state, and there is severe flu activity in 32 states, CDC reports. The elderly and young children are most at risk of severe disease or death.

In North Carolina alone, 42 adults have already died from the flu this season, CDC Director Brenda Fitzgerald said in a recent interview with Reuters. She added that of the 30 children throughout the country who have died from the flu so far this season, about 85% had not been vaccinated.

“Please get your children vaccinated,” Fitzgerald told Reuters.

The vaccine is estimated to be only about 30% effective against the H3N2 strain. However, CDC leadership said the vaccine has been shown in studies to reduce severity and duration if people do become infected.

And while you’re at it, Fitzgerald said, take other precautions such as washing hands frequently and steering clear of others who are sick.

This, of course, goes without saying for healthcare workers, who will see their fair share of flu patients walk through their doors the rest of this season.

Before taking office, President Donald Trump expressed a desire to trim the federal workforce, something he has taken action on since getting sworn in last year.

OSHA is reportedly one of the federal agencies that have been impacted.

According to data obtained by NBC News through a Freedom of Information Act request, OSHA has lost 40 inspectors through attrition since Trump took office last January, and as of October 2, the federal agency had made no new hires to replace them. The 40 vacant positions represent 4% of the OSHA’s total federal inspection force, which fell below 1,000 in early October, according to the NBC News report.

A Labor Department spokesman told NBC News that OSHA has hired “several additional inspectors” since early October and is currently recruiting at least two dozen more. Still, even if OSHA is allowed to fill some of those open positions in the coming months, last year’s hiring lull could affect the agency’s future performance, argued Jordan Barab, an OSHA official under former President Barack Obama.

“Even after OSHA hires someone, they can’t just send them out to do an inspection by themselves,” Barab told NBC News. “This will have an impact for years.”

Meanwhile, due to limited resources and manpower, OSHA is prioritizing high-risk workplaces — such as construction sites and manufacturing plants — with increased rates of fatal accidents, serious injuries, and illnesses, the report said. It is not yet clear how much impact the loss of inspectors has had on the healthcare industry.

According to the Labor Department, OSHA from October 2016 to September 2017 actually increased its number of inspections for the first time in five years, NBC News reported. But some activists, politicians, and former OHSA officials argue the loss of on-the-ground inspectors in specific regions expose workers to greater risk.

“OSHA is far too understaffed to fulfill its mandate of reducing workplace injuries,” U.S. Representative Rosa DeLauro, a Democrat from Connecticut, told NBC News. “Under the Trump administration, OSHA has suffered a troubling decline in both staff and work-place inspections in key areas of the country.”

“Noise is a distraction that interrupts patient care and potentially increases the risk for error,” Mary J. Ogg, MSN, RN, CNOR, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN), told OR Today. “It may minimize the ability of OR team members to communicate effectively, making it difficult to understand content and contributing to miscommunication.”

And that not only puts patients in peril, but potentially your employees, too.

A lack of focus in the OR could result in accidental injuries to surgeons or one of their assistants via needlestick injuries or knife cuts, for example.

Plus, as Ogg told OR Today, excess noise in the OR can negatively impact employees because it “is associated with job dissatisfaction, irritability, tachycardia, anxiety, fatigue, illnesses, stress, emotional exhaustion, burnout and injury.”

The article cited one study that found that the average noise level during OR trauma procedures was 85 decibels, nearly double the EPA-recommended limit of 45.

In addition to medical equipment such as powered surgical instruments and clinical and alert alarms, Ogg said common sources of noise in the OR include HVAC systems, phones and audio players, and non-case-relevant chitchat.

OR Today offered suggestions for reducing noise and distractions in the OR. The list included turning off cell phones and personal music devices (or leaving them outside the OR), limiting the amount of foot traffic in and out of the OR, and evaluating the noise level of medical equipment while deciding which devices to purchase.

Is scrubbing into the operating room akin to walking onto a busy construction site?

A study published online last week in the Journal of the American Medical Association (JAMA) found that the prevalence of work-related musculoskeletal disorders (MSDs) among at-risk physicians, defined as surgeons and interventionalists, is comparable to what is reported among industrial workers and other high-risk laborers.

Citing “long work hours involving repetitive movements, static and awkward postures, and challenges with instrument design” endured by procedural physicians in operating rooms, researchers said they appear to face a high risk of developing MSDs.

Researchers examined 21 articles in their meta-analysis. Of the 5,828 physicians that made up the data pool, 19% had degenerative lumbar spine disease, 18% had rotator cuff pathology, 17% had degenerative cervical spine disease, and 9% had carpal tunnel syndrome. Researchers also noted that from 1997 to 2015, the prevalence of degenerative lumbar spine disease and degenerative cervical spine disease increased by 27% and 18.3%, respectively.

In addition to the pain an estimated 35% to 60% of physicians with a work-related MSD experienced, the study found that 12% of those physicians required a leave of absence, had to make changes or restrictions to their practice, or were pushed into early retirement — concerns that the researchers say continue to be overlooked.

They concluded that “given the impending physician shortage, this problem warrants prompt attention and action” and “further research is needed to develop and validate an evidence-based applied ergonomics program aimed at preventing these disorders.”

Until the healthcare industry does that, work-related MSDs are likely to continue to take a physical toll on procedural physicians while also costing hospitals and clinics financially via workers compensation payouts and decreased productivity.

After a follow-up visit by state surveyors late last month, a Missouri hospital has had its second “immediate jeopardy” finding this year lifted. But the facility remains out of compliance.

Mercy Hospital Springfield retains its CMS certification despite continuing to fall short of the Conditions of Participation (CoP) pertaining to nursing services and patient rights, a spokesperson for the CMS regional office in Kansas City said this week. Surveyors will return to the facility once again this month to determine whether the hospital has brought its operation into compliance with the CoPs, the spokesperson said.

In January, surveyors faulted the hospital’s Behavioral Health Unit (BHU) for failing to properly handle certain tense situations, including one incident that involved a scuffle between a nurse and a patient diagnosed with schizoaffective disorder. That survey resulted in an immediate jeopardy finding, but the status was removed when the hospital provided an immediate action plan to remedy the situation. The BHU worker involved in the scuffle was placed on administrative leave in January, then his employment was terminated in February.

In April, a follow-up visit determined that the hospital’s condition-level deficiencies had been corrected, though there were still standard-level citations pertaining to patient rights, according to records obtained via state and federal public records requests.

In August, the hospital was found in immediate jeopardy once again and given less than a month to address its problems or lose Medicare funding. The facility fired 12 workers, implemented new and additional training modules, and brought in an interim leadership team before surveyors returned for their follow-up visit.

One former nurse in Mercy’s Emergency Department (ED) wrote an opinion piece for the Springfield News-Leader defending the fired workers. David Schneider, a traveling nurse, argued that ED staff are subjected to verbal and physical threats and abuse on a daily basis, adding to the difficulty of their jobs.

“Health care staff in Springfield are being abused by members of the community on a daily basis and as the result of the employee terminations at Mercy … many of those health care members now feel more unsafe,” Schneider wrote.

Additional detail on the Statement of Deficiencies and Plan of Correction stemming from the August inspection are not yet publicly releasable but should be available soon, the CMS spokesperson said.

A hospital spokesperson didn’t respond to my request for comment this week, but the News-Leader reported that the hospital released a statement Friday announcing that the immediate jeopardy had been lifted. Jon Swope, interim president of Mercy Springfield Communities, thanked the hospital’s stakeholders for their input and hard work in implementing a variety of changes.

“I’m certain Mercy Hospital Springfield will be even better because of these efforts,” Swope said in the statement, as the News-Leader reported. “We are empowering our co-workers with additional skills and resources so they may fully cherish the dignity of every individual we serve.”

The annual list of most-frequently cited OSHA standards was released this week at the National Safety Center (NSC) Congress & Expo in Indianapolis. Although the list looks pretty similar to years past, there has been some movement.

The hazard communication requirements (1910.1200)—which are especially pertinent to healthcare employers and other industries where workers handle hazardous substances—have held steady as the second-most-frequently cited set of OSHA standards.

Citations related to electrical wiring (1910.305) have continued their downward trend relative to the other top standards, moving from eighth place to 10th in two years. This year’s ninth-place finisher, fall protection training requirements (1926.503), jumped onto the list for the first time in recent memory.

For more detail on the OSHA standards for the past three years, review the chart below. (Or click here for the PDF version.) The numbers associated with each category indicate the number of violations cited under each set of standards. These numbers are based on each fiscal year, and they are considered preliminary. A final report will be published in the December edition of NSC’s Safety+Health magazine.

A hospital in Missouri had been given until September 22 to bring its operation into compliance with the CMS Conditions of Participation (CoP) after surveyors last month found significant problems pertaining to nursing services and patient rights. That deadline has been suspended, however, as federal regulators review the findings of a follow-up visit.

State surveyors returned last week to Mercy Hospital Springfield to determine whether the facility has fixed the problems that led to the “immediate jeopardy” findings in August, a spokesperson for the CMS regional office in Kansas City said this week. Suspending the deadline gives CMS time to review what the follow-up surveyors found, the spokesperson said.

In early September, the hospital announced that it had recently fired 12 employees after determining that their behavior in “highly tense situations” had been inadequate. Remaining staff members would receive additional training on de-escalation techniques and preventing patient abuse and neglect, the hospital said. The following week, an interim leadership team stepped in.

“Everything we’re doing is to ensure the well-being and safety of everyone, including our co-workers,” hospital spokesperson Sonya Kullmann said.

Details from the August inspection are not yet publicly available, but records obtained via the Missouri Sunshine Law and the federal Freedom of Information Act indicate that Mercy Hospital Springfield has struggled recently to recognize incidents of possible abuse and neglect. The Missouri Department of Health and Senior Services and CMS each released the findings of a complaint investigation conducted in early January and the hospital’s subsequent plan of correction. (To review the 219 pages of records released by the state, download the PDF.)

Corrective steps being taken to protect patients and workers alike, hospital says

A hospital in Missouri at risk of losing its Medicare funding within the month installed an interim leadership team this week as it seeks to appease federal inspectors.

Mercy Hospital Springfield was placed in “immediate jeopardy” by CMS after an inspection last month found significant violations of the regulations pertaining to nursing services and patient rights. The hospital announced last week that it had fired 12 employees whose behavior in “highly tense situations” was deemed inadequate. That news was followed Tuesday by an announcement that the interim leaders would step in to right the ship.

“They bring a fresh perspective and will help bolster local resources,” said Jon Swope, interim president of Mercy Springfield Communities, in a statement announcing six temporary leaders.

Facility accused of failing to address workplace violence risks it had promised to remedy

A psychiatric treatment center in Massachusetts faces more than $207,000 in proposed penalties after OSHA accused the facility of failing to adequately protect employees from workplace violence, despite having promised specifically to do so.

Notice of the proposed action against Lowell Treatment Center, which is operated by UHS of Westwood Pembroke Inc., comes as OSHA has grown significantly quieter about its enforcement activity under President Donald Trump’s administration than it had been under former President Barack Obama. There have been fewer enforcement-related OSHA press releases issued in the seven months since Trump took office than there were in just the final month of 2016.

It remains unclear how OSHA decides which enforcement actions warrant a press release. An agency spokesperson was not immediately able Wednesday to answer questions about this threshold. But we know that this case entails allegations that the facility failed to keep specific promises it made last year in a formal settlement agreement stemming from an unfavorable 2015 evaluation by federal inspectors.

“Our inspectors found that employees throughout the Lowell Treatment Center continued to be exposed to incidents of workplace violence that could have been greatly reduced had the employer fully implemented the settlement agreement,” OSHA’s Boston-based regional administrator Galen Blanton said last week in a written statement.

The management company, which operates 350 facilities throughout the United States and United Kingdom, notified OSHA that it intends to contest the findings, according to the press release.

Micah Smith, an OSHA attorney with Conn Maciel Carey in Washington, D.C., said during a webinar Tuesday that the Obama administration had engaged in “regulation by shaming.” And any Republican in the White House would be expected to back off of Obama-era levels of enforcement, he said.

“We’re expecting to see this change, and that press-heavy enforcement model to be rolled back,” Smith said. “We haven’t seen any official actions, but in the early days of the administration, most agencies across the government have been encouraged or required to reduce their press activity.”

Smith said there were two or three OSHA enforcement press releases in June and July this year, compared to 25-40 for each of the same months last year. Even so, it’s important to note that OSHA’s priorities are just as unsettled as its staffing.

“As with all things, without the permanent OSHA team in place, we’re still reading the tea leaves a little bit,” Smith said.

The press release in this case comes two months after OSHA endured criticism for backing off an allegation that Bergen Regional Medical Center (BRMC) in Paramus, New Jersey, had an inadequate workplace violence prevention plan. Jordan Barab, a former OSHA official under Obama, drafted a lengthy blog post critical of the move, and he clashed on Twitter with Eric Conn, another attorney with Conn Maciel Carey, who was hired to represent BRMC’s defense against the citation.

Barab, who has also been critical of the marked decrease in the issuance of OSHA enforcement press releases, hasn’t blogged since OSHA issued its press release last week.

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Update (8/23/17): Barab blogged yesterday about this case. “Although I am frequently critical of OSHA under the Trump administration,” he wrote, “never let it be said that I have failed to praise the agency when they do something good.”

Report: Suspicious package that prompted mini-emergency was letter from government agency

If you subscribe to HCPro’s monthly Briefings on Hospital Safety newsletter, you will recall the story of a hazardous material scare and emergency lockdown at Frederick Memorial Hospital in Maryland. Two men opened a piece of mail at home in May, discovered a suspicious substance inside, and began experiencing skin and respiratory irritation, so they went to the local ED—and brought the unknown substance with them. That, of course, sent hospital staff scurrying to contain the threat.

Because the men live across the street from the U.S. Army’s Fort Detrick, a hub for biodefense research, there was added concern that the substance might be a biological agent. That turned out not to be the case. Investigators quickly identified the substance as a relatively common household chemical. But the circumstances leading up to that hazmat scare and lockdown, as reported in the local newspaper, are still baffling.

The substance that caused the hubbub was ultimately determined to be an ingredient found in rat poisoning, The Frederick News-Post’s Jeremy Arias reported last week. That substance was delivered in an envelope from the National Institute of Standards and Technology (NIST) in Gaithersburg, Maryland, to the home address of Jay Zimmerman, who said he had held a position with NIST for 33 years. The envelope also reportedly contained a letter from NIST informing Zimmerman that he would be removed from his position.

Zimmerman, who retired from NIST in June, told the News-Post that he believes his former employer used the substance to target him as an act of retaliation because Zimmerman had filed a complaint against NIST earlier this year alleging discrimination and harassment on account of his sexual orientation and disability. A spokesperson for NIST declined to comment on the allegations, citing the Privacy Act.

“There is nothing on the video that appears to be suspicious or that indicates any of that substance was put into the package at that point,” Alcorn said.

Although the case was officially suspended without any charges being filed, the resulting response gave Frederick Memorial an opportunity to test its own emergency preparedness.

“When events like this take place,” said Phil Giuliano, the hospital’s director of public safety and security, “I think it’s a reminder for hospital staff, hospital leaders, and community members as a whole how important it is to have strong relationships, to maintain strong relationships with those other partners you have in your county, in your jurisdiction, in your area of operations.”

For more on this story and how Frederick Memorial kept its workers and patients safe, be sure to read the News-Post’s full report and the August edition of Briefings on Hospital Safety.